ADOLESCENT INPATIENT

Similar documents
Outpatient Services. Partial Hospitalization Program (PHP) & Intensive Outpatient Program (IOP) Patient Handbook. Bringing Life Into Balance

Welcome To Inpatient Psychiatry

Patient Handbook Inpatient Psychiatric Program. Welcome to 1 East Inpatient Psychiatric Services at Saint Joseph Mercy Hospital.

at Bergen Regional Medical Center

Inpatient Rehabilitation Guidebook

Welcome to Wintle Ward

ST. LUKE S ACUTE REHABILITATION CENTER PATIENT/FAMILY GUIDELINES

rehabilitation Admissions Inpatient Rehabilitation at A list of things to bring

Summit Oaks Hospital. Summit Oaks Hospital 19 Prospect Street Summit, New Jersey (908) Main Number (908) Direct to Unit

RESIDENTIAL FACILITY, 122 W. Hill Street, Champaign, Illinois

TITLE CLIN_117 SUICIDE PRECAUTIONS IN THE ACUTE HOSPITAL NON-PSYCH SETTING

GETTING HELP AT PEACHFORD

Patient and Family. Education. Comprehensive Acute Rehabilitation Unit. Redefining Healthcare THOMAS JEFFERSON UNIVERSITY HOSPITALS

Inpatient Rehabilitation Patient Handbook

Adolescent Ward Inpatient Program

Spine and Orthopedic Surgery Unit Hamilton General Hospital. Information for patients and their families

Aurora Behavioral Health System

Renee Bellis, PsyD, CSAC Clinical Psychologist & Certified Substance Abuse Counselor 850 West Hind Dr. Suite # 110 Honolulu, HI P(808)

The PEER RECOVERY SPECIALIST provides peer mentoring, support and education during your stay.

How To Be A Successful Patient At Select Rehabilitation Hospital Of Denton

COMMUNITY WEEKEND INTERVENTION PROGRAM

Medical stability Ability to participate and learn Consent and willingness to participate

THE ROYAL HOSPITAL DONNYBROOK. General Rehabilitation Unit Information Leaflet

Spinal Cord Injury Program

Your Guide to Outpatient Surgery

NEXT STEP RECOVERY WOMEN S PROGRAM Introduction to Program Standards

UK INTERNATIONAL RESIDENTIAL CAMP F.A.Qʼs

Inpatient Rehabilitation

Patient s Handbook. Provincial Rehabilitation Unit ONE ISLAND HEALTH SYSTEM ONE ISLAND FUTURE 11HPE

Welcome to B2 North Stroke Rehabilitation

College Student Control Journal

Rehabilitation Services Welcome & Information Pack

How To Care For A Disabled Person

Provincial Rehabilitation Unit. Patient Handbook

Summit Music Festival

Riverside Nursing Home

A GUIDE TO BEHAVIORAL HEALTH

Rehabilitation Center

Student Control Journal Parents keep away

STEPHEN CENTER HERO Program ~ Health, Empowerment, Responsibility and Opportunity ~

Renaissance Academy Charter School

Welcome to the Pediatric Eating Disorders Program Information about the Day Hospital Program

Eating Disorders Program

St. Mark s House Residential Detoxification. Client Guide

Involuntary Commitments and Psychiatric Hospitals

Holdrege Nebraska. Unity Houses. Providing a safe and affordable living environment for adults recovering from addiction.

Life Changing Treatment For The Real World

COLUMBIA COLLEGE HOMESTAY PROGRAM STUDENT HANDBOOK

St. Mark s and Ashton House Residential Rehabilitation. Client Guide

Frequently Asked Questions (FAQ) Phoenix House New England

Intensive Outpatient Program Parent Handbook

Information for Your Stay

Surrey Memorial Hospital

Lincoln University Summer Transportation Institute (STI) Program

Welcome to the Child/Adolescent Mental Health Inpatient Programs

Frequently Asked Questions and Sample Schedule Partial Hospital and Intensive Outpatient Program

Informed Consent for Counselling at the University of Lethbridge 1

WELCOME. t o Alta View Hospital

FOR IMMEDIATE RELEASE. North Suburban Human Rights Authority Report of Findings Streamwood Behavioral Health System HRA #

PALM HOUSE RECOVERY CENTER RECOVERY RESIDENCE RESIDENT HANDBOOK

Policy and Procedure Manual

No Personal Checks! Only Cash, Cashiers check or Money order made out to Joan Maynord will be accepted

Northside West Clinic

Rehabilitation Services

WESTWOOD PRESCHOOL HANDBOOK

Welcome to the acute medical unit. A patient guide

Patient s Bill of Rights For Mental Health Services

MOVE - IN. dates and times QUICK HOUSING FACTS. FLORIDA MEMORIAL UNIVERSITY Department of Residential Life AUGUST 12, 2015 AUGUST 14, 2015.

Minnesota Patients Bill of Rights

RULES OF THE DEPARTMENT OF MENTAL HEALTH AND DEVELOPMENTAL DISABILITIES OFFICE OF LICENSURE

ADOLESCENT EATING DISORDERS PROGRAM

Esther Aloia. Brentwood High School Preschool Program 3601 Brownsville Road Pittsburgh, PA PROGRAM

Minnesota Patients Bill of Rights Legislative Intent

Medical Rehabilitation. Rehabilitation Unit

Patient and Family Information Guide for Rehab Inpatient Unit

Endovascular Abdominal Aortic Aneurysm Repair Surgery

Policy: Family Presence / "Visitor" Guidelines

Welcome to 5 South Geriatric Psychiatry

Iodine-131 Treatment of Thyroid Cancer Information about your treatment November 2011 Great Staff Great Care Great Future

Patient s Bill of Rights

Sanzie Healthcare Services, Inc. Nurse Aide Training Program Policy

Client Rights Handbook. Your rights and responsibilities as a consumer of Access Family Services, Inc.

DALLAS COUNTY SHERIFF S OFFICE

Mental Health Services

RESIDENTIAL NEUROBEHAVIORAL TREATMENT FOR CHILDREN AND ADOLESCENTS PARENT PACKET

Contents. Overview Treatments Inpatient Services Day Programs The Clinic What are the Costs? How to Get Started How to Find Us

PSYCHOTHERAPY CONTRACT

Northside Cremorne Clinic

ARTICLE 3. BEHAVIORAL HEALTH INPATIENT FACILITIES

Every member of our healthcare team has a specific role in maintaining the high quality of care that distinguishes the hospital.

Policy and Procedure Manual

Patient Rights and Responsibilities

Transcription:

ADOLESCENT INPATIENT 2960 SLEEPY HOLLOW ROAD FALLS CHURCH, VA 22044 703-531-6130 ADOLESCENT INPATIENT DIRECT LINE 703-538-2872 ASSESSMENT & REFERRAL 703-536-2000 HOSPITAL MAIN LINE v.2

INPATIENT PHILOSOPHY The goal of inpatient treatment is to provide quality care in a safe and nurturing environment. Using the principles of recovery, Dominion Hospital will support each individual in taking an active role in their treatment while various members of the staff help teach and guide individuals into an improved state of being. We understand that this can be a time of great stress and may result in many questions or concerns about admission at Dominion Hospital. The purpose of this handbook is to provide the guidance necessary to ensure a therapeutic stay at Dominion Hospital. For some, this may be their first admission to a behavioral health facility, while others may have had previous admissions here or elsewhere. The structure and activities on the unit are deliberately designed to imitate life outside of the hospital. That means that while there are various types of therapy, there is also structured leisure and free time to emulate daily life outside of the hospital. Please know that we are in a constant state of quality improvement and strive to provide the best care possible. Any feedback is welcomed about each individual s experience here. Finally, while here, we invite you to envision yourself well. We hope that we can provide the guidance necessary to restore each individual to a state of recovery. It is not an easy journey, but the reward is great. A tip for navigating the handbook: The handbook is divided by topics and arranged alphabetically.

BILLING Individuals who are currently enrolled in Dominion Hospital s inpatient program, Partial Hospitalization Program (PHP) or Intensive Outpatient Program (IOP) should contact the Billing Manager at 703-531-6103 with billing inquires. For individuals who are no longer enrolled in any program, billing inquiries should be directed to RPAS at 866-823-7612. CONCERNS/COMPLAINTS Program staff strive to provide high quality and safe care in a dignified fashion. Should a concern arise, the staff will attempt to solve the problem at the program level. If you feel your concern is not resolved or you would like to voice your concern directly please feel free to contact the Hospital Patient Advocate at 703-538-2882. After hours, a nursing supervisor is on duty to assist with concerns and issues and can be reached by calling 703-538-2875. Individuals receive a copy of the Patient Rights form at admission. Please see the unit staff should another copy be needed. Additionally, Dominion Hospital is accredited by The Joint Commission (TJC). If you have any concerns about individual care or safety which have not been addressed by the hospital, you may contact the TJC for general questions at 800-994-6610 or for complaints: Via email at complaint@jointcommission.org Via fax at 630-792-5636 By mail at: Office of Quality Monitoring The Joint Commission One Renaissance Boulevard Oakbrook Terrace, Illinois 60181

CONSULT WITH OUTSIDE THERAPISTS OR PSYCHIATRISTS If it would be benefit an individual s treatment for their psychiatrist or social worker here to be able to speak with their outside treatment provider, the individual or family member should provide the outside provider s name and phone number and sign a written release allowing the Dominion Hospital treatment team to speak with them. CONTRABAND At Dominion Hospital, safety and comfort are important to us, as is the comfort and safety of the community within the unit. All items not allowed on the unit reflect items that are safety issues and/or items that could potentially cause a breach of privacy. Please note that this is not an all-inclusive list. The following items are never allowed on the units: Items made from glass or ceramic (i.e. mirrors, vases) Metal items such as aluminum cans, metal lids, metal hair clips, metal barrettes, bobby pins, paper clips, pens with metal caps, etc. Toiletries with metal pieces (i.e. lotion pumps) Floral arrangements Blankets, towels, pillows, or other linens from home Disposable/straight razors Spiral notebooks or 3 ring binders Aerosol products (i.e. hairspray or spray on deodorant) Plastic bags and plastic shower caps Strings, shoe laces, cords Knives or weapons of any kind

Contraband (cont.) Electrical devices such as MP3 players, CD players, stereos, computers/laptops, cameras, etc. DVDs/movies Musical instruments Belts, necklaces or scarves Thumbtacks, safety pins, sewing/crochet needles Tweezers or nail clippers Nail polish or nail polish remover Feminine products from home Lighters and matches Toxic materials including spray paint and markers not labeled non-toxic Alcohol or narcotics including street drugs or drug paraphernalia Weapons or potential weapons Pornography Reading material about substance abuse, sexual activity, Satanism, or violence (books and puzzle books are normally allowed but content must be reviewed by staff) Pets Valuables such as wallet or cell phone Jewelry of any kind Luggage Medications from home, including over the counter (OTC) medications (unless requested by staff) Any item deemed unsafe/hazardous by the charge nurse or the unit director

CUBBY TIME Individuals can access items that are stored in their cubby as long as the items are not on the contraband list. Toothpaste, shampoo, etc. in flattened tubes or pump bottles will be dispensed to individuals in a paper cup. Cubby times are: 7:30-8:00am (Before breakfast) 3:00-3:30pm (Afternoon snack time) 6:00pm (After dinner) 8:30-9:00pm (Before bed) DISCHARGE Prior to discharge, each individual will receive a discharge packet that includes their individual discharge plan and a patient satisfaction survey. The individual s Social Worker will help each individual make their discharge appointments and complete the necessary elements of the discharge packet. Outpatient appointments must be made before discharge. The date and time of the next appointment as well as the provider and their telephone number must be included on the form. On the day of discharge, staff will return all personal belongings, including sharps and valuables. Individuals will be asked to review each items returned to them and inform staff of any missing items. Individuals are responsible for packing up their rooms for departure; however, staff can assist if needed. Individuals must arrange for transportation on the day of discharge. Individuals should remain on the unit while waiting for their transportation.

DRESS CODE Individuals are expected to wear comfortable clothing in keeping with the setting. Shoes or hospital socks must be worn outside of the individual s rooms. Nightgowns and robes are limited to the individual s room only. Clothing that interferes with the therapeutic environment is unacceptable and may include: violent, graphic, or otherwise inappropriate images or words on them will not be allowed, nor will low cut tops or shorts. Nudity or partial nudity is never appropriate and is discouraged. If an individual is unable to comply with the dress code, privilege levels may be affected. EDUCATION As an element of the treatment plan, individuals will attend Dominion Hospital s school program for two hours each weekday. During this time, individuals will receive instruction in mathematics, science, language arts, and social studies, in addition to health and/or expressive therapy. Goal setting and psychoeducation are also critical components of this program. In order to evaluate an individual s educational needs, a school staff member will complete an Initial Education Assessment (IEA). This IEA will provide valuable information regarding academic and emotional needs. Grades are awarded based on behavior, participation, and effort, and will be included in a Final Grade Report (FGR). Think of the school program as a way to maintain, or even improve current grades, and to keep any makeup work to a minimum. Adolescent inpatients are typically not encouraged or required to receive or keep up with assignments from their school. This practice is usually reserved for Partial Hospitalization Program (PHP) patients. Typically, this will allow each individual the best opportunity to fully access and benefit from their treatment. However, if a individual is

stable enough, and if it is determined beneficial to their treatment to have work from their school, assignments may be brought in by parents/guardians. No three ring binders, spiral notebooks, paperclips, or staples are allowed (see Contraband list). Please make sure that the individual s name is in all of their textbooks and on all of their materials, and that everything is taken home upon discharge. FAMILY THERAPY Individuals make better progress when their families are involved. The individual s assigned social worker will contact their family to set up an initial appointment with 72 hours of admission. The initial family meeting might be with a weekend social worker. Normally, there will be two family meetings during the week for about an hour per session. INDIVIDUAL RESPONSIBILITES 1. You have the responsibility to cooperate with all hospital personnel caring for you during your stay. You have the responsibility to ask questions if you do not understand directions or education that is provided to you. 2. You have the responsibility to be considerate of other patients and to see that your visitors are considerate as well. 3. You have the responsibility to be respectful of others, of other people s property, and of the Hospital s property. 4. You have the responsibility to abide by hospital rules and regulations. 5. You have the responsibility of minding your personal items that are not stored in the hospital safe. 6. You have the responsibility to disclose all medications you are taking to the hospital staff and physicians.

Individual Responsibilities (cont.) 7. You or your guardians/ legal decision makers have the responsibility to provide to the hospital staff any advanced directives, or legal documents such as custody agreements, etc... 8. When you leave the hospital, you have the responsibility to maintain the treatments recommended with medications, your safety plan, and after care appointments. LEISURE ACTIVITIES The daily schedule on the unit is designed to parallel that of the normal daily lives of adolescents. The program includes periods of leisure time in the evenings and on the weekends. During these times, individuals will be permitted to engage in such supervised activities as watching movies selected by staff, reading, playing games or going to the gym. Leisure Activities (cont.) All leisure activities are monitored by staff to ensure appropriateness to the therapeutic milieu. There are some restrictions on the types of movies that may be watched and the types of activities permitted. Only movies rated PG-13 or below will be accepted and no horror movies or movies with excessive violence, foul language, sexual content or drug related themes will be permitted regardless of the rating. LENGTH OF STAY The average length of stay for an adolescent is 5 to 7 days. An individual s actual length of stay will depend on how well they respond to their psychiatrist and treatment team and how long parents/guardians feel you need to be at the facility. LINENS AND LAUNDRY

Sheets, blankets, washcloths, and towels are kept by nursing staff and will be provided to individuals upon request. Individuals are responsible for making their own beds and keeping their areas organized. There is a laundry room located on the unit. Staff can provide laundry detergent and accompany individuals to the laundry room. Soiled hospital linens, such as bed sheets and towels, are to be placed in the hampers. Please see staff regarding the hamper s location. MAIL/PACKAGES/FLOWERS Individuals are free to send and receive mail. Stamps will not be provided by the hospital. Mail must be opened in front of a staff member but can be read privately. The mailing address for patients is: Dominion Hospital C/O 3 North, Adolescent Unit Individual s Name, Patient ID # 2960 Sleepy Hollow Road Falls Church, VA 22044 Due to privacy concerns, Dominion Hospital will not forward individual mail after discharge. It is the individual s responsibility to advise family, friends and business contacts of their forwarding address.

Packages received during an individual s stay must be opened in the presence of staff. Floral arrangements are not allowed on the unit. MEALS All meals will be eaten in the cafeteria, located on the 1 st floor, unless their treatment plan indicates otherwise. In order to go to the cafeteria, individuals must be appropriately dressed, wear shoes and be ready at the nurses station at the designated times. If it is deemed best that an individual eat meals on the unit, a tray will be delivered to the unit and will be handed out by staff. Meals on the unit will be eaten in an area designated by staff. For safety purposes, use of plastic utensils will be monitored. On the weekends, a continental breakfast is served on the unit for all patients. No food is allowed in individual s rooms and will be disposed of if found by staff during room checks.

Light snacks, ice, water, milk, and juice are available on the units. Individuals with allergies or a need for special menus will have designated trays that will either be delivered to the unit or handed out by staff in the cafeteria. Meal times are as follows: Monday-Friday: Breakfast 8:30-9:00am Lunch 12:00-12:30pm Dinner 5:30-6:00pm Saturday and Sunday Continental Breakfast 9:00-10:00am Lunch 12:00-12:30pm Dinner 5:30-6:00pm MEDICAL RECORDS/ RELEASE OF INFORMATION Continuing care is important to us and we will be happy to provide an individual s Healthcare Providers with copies of their medical record. Individuals may also need copies for insurance purposes, legal purposes, and for their own individual use. Unit staff will provide an Authorization for Release of Written Protected Health Information. This form must be completed in its entirety and signed by the individual (for ages 14 or older) and parent (unless individuals are 18 or older).

Medical Records/Release of Information (cont.) The request will be processed by the Health Information Management (HIM) Department according to the instructions on the form. Under law, the HIM department has 15 days to comply with a request for records but we make every effort to have the requests completed within one week. If you have any questions about your records and obtaining copies, please call the HIM Department at 703-531-6105. MEDICATIONS If the psychiatrist feels an individual needs to be treated with medications, he or she will contact the individual s parents/guardians for permission. If an individual was on medications prior to admission, parents/guardians will normally consent to those medications at admission. If there is a psychiatric emergency, and an individual is a danger to one s self or others, their psychiatrist may order emergency medications to help them calm down and will inform parents/guardians afterward. Antibiotics or pain medication can be ordered by the Internist. The same process will be followed for medications for asthma, seasonal allergies, or other problems of a medical nature. These types of medications do not require consent from parents/guardians.

PATIENT IDENTIFICATION PASSCODE The privacy of individual information is second only in importance to individual care itself. All information about individuals is confidential. In order to better protect each individual s privacy, a four (4) digit passcode will be assigned for individuals to provide to family members or friends with whom the Hospital can share personal health information (PHI). Family or friends seeking information will need to provide this passcode to the nurse or other hospital employee that they are speaking with, in order to receive any information. The passcode will serve as authorization to disclose PHI for purposes such as communication results, findings and care decisions to family or friends. The facility is not responsible for distribution of this passcode and will assume that the individual is taking reasonable measures to protect their passcode. For more information, please contact the Facility Privacy Officer at 703-531-6106. PATIENT SAFETY/OBSERVATION One of Dominion Hospital s most important goals is to ensure that all individuals receive treatment in an environment that is safe and secure. Upon admission and during the course of hospitalization, there will be ongoing assessments of an individual s safety. All individuals require varying levels of structure and support in order to maintain safety. The following precautions are instituted for safety: Unit Restriction (UR): See description to right. Sharps Restriction (SR): May not check out items on the sharps list. All patients are on sharps restriction for at least 24 hours after admission but may require more time due to various treatment reasons.

Patient Safety/Observation (cont.) Falls Risk (FR): The treatment team will determine if an individual is a falls risk. An individual may require a falls alarm at night or additional interventions as ordered by the treatment team. 15 Minute Checks One of the main components of safety precautions on the inpatient units are 15 minute checks. A staff member must observe each individual every 15 minutes during their stay. This will require that the staff member open your door and look at the individual throughout the day and night. More frequent monitoring may be instituted if an individual is assessed to have the potential to harm themselves or others or if their behavior is such that it may potentially be harmful or disruptive to others. Unit Restriction When a new individual arrives on an inpatient unit, they will be restricted to the unit until cleared by their attending psychiatrist, the internist, clinical manager and other members of the treatment team. This is normally accomplished within the first 24 hours. If an individual engages in self-injurious behaviors (cutting, scratching, burning, etc.), that individual will be on unit restriction for the next 24 hours. To be able to leave the unit again, the individual will need to demonstrate that they can remain safe by processing the event with staff and by being able to demonstrate safe, effective coping skills in lieu of self-injury. If an individual engages in threatening or aggressive behavior, are unable to follow basic staff instruction, otherwise demonstrates that they are a danger to themselves or others, or poses a severe elopement risk, that individual will not be able to leave the unit until the treatment team determines that the individual is safe again.

PATIENT SATISFACTION SURVEY At the time of discharge, each individual will be provided an opportunity to complete the hospital s Patient Satisfaction Survey. Individuals are encouraged to take a few moments to rate the services that they received at Dominion Hospital during their stay so that the hospital can continue to enhance and improve the care we provide. All responses are voluntary and confidential. PSYCHOLOGICAL TESTING After a psychiatrist evaluates an individual for the first time, he or she may have treatment recommendations immediately. If an individual s diagnosis is not clear, he or she may ask a clinical psychologist to spend time with the individual to clarify a diagnosis to ensure that any treatment recommendations are based on the best diagnosis possible. RELATIONSHIPS Relationships formed in treatment are for the purpose of treatment. Outside communication may distract individuals from focusing on their treatment or detract from obtaining maximum benefits from treatment. No sexual activity, hugging or handholding is permitted on the units. Hospitalization is a vulnerable time and discretion is strongly advised in developing relationships. Individuals may not visit in another individual s room, even if they are of the same gender. Sexual relations are prohibited at all times, under all circumstances. Staff encourage individuals not to give out personal information to other patients, including telephone numbers.

ROOM ASSIGNMENTS/UNIT LAYOUT Individual Rooms Individuals may share a room with one or two other individuals. Individuals cannot be guaranteed a private room. Each room has two or three single beds, built-in closets, and drawer space. Only members of the same sex will share a room. Toilet and bathing facilities are located in each individual room. Admissions and discharges may require reassignment of rooms. Individuals are expected to keep their areas organized and their beds made. Self-care is the responsibility of each individual. Individuals will be responsible for attending to their own personal needs, such as hygiene, laundry, and storing their belongings in the drawers and closets provided. No items may be taped to the walls, doors, windows or furniture in the room. Common Rooms/Lounges There are common areas/lounges on each unit for use. Individuals are responsible for straightening up the lounges after use. Tables and chairs must be neatly arranged. Papers, food containers, and other garbage must be disposed of properly. Environmental Rounds Environmental rounds are completed daily by staff to check on cleanliness and overall room condition including the need for maintenance repairs or attention from housekeeping. Individuals are encouraged to report to staff any needed maintenance repairs they observe.

Room Assignments/Unit Layout (cont.) Room Checks A room check is a more thorough check of individual s rooms and personal belongings. Room checks are done randomly or when staff have a reason to believe there may be restricted items or contraband present. Room checks include the search for food or beverages as well as unsafe items. It is important to note that individuals may not store any food or beverages besides water for infection control purposes. Items found and deemed unsafe will be automatically returned to the Nurses station or disposed of appropriately. This is done to maintain the safety of the unit. Alcohol, Drugs, Drug Paraphernalia Any alcohol, drugs, or drug paraphernalia found during a room or belongings search will be immediately confiscated and the individual s physician will be notified. Additionally, staff are required to notify local police if any illegal drugs are found on the unit. Bed Times Individuals are expected to be in their rooms preparing for sleep at the following time by 10:00pm.

SAFETY MEASURES Staff will provide support and encouragement in dealing with difficult situations. If an individual is making choices that are disruptive to others rights to treatment, or that are resulting in an unsafe situation, the staff will utilize the following options to help an individual make better choices and keep themselves and others safe. These options are used as needed to ensure consistency of staff-individual interactions, to assist individuals in learning more appropriate coping skills and in maintaining the safety of all individuals on the unit. The following interventions may be incorporated into an individual s treatment plan: Redirection: Staff will request that an individual stop a specific unacceptable behavior. Dining Room Restriction: An individual will be restricted from eating in the dining room when their behavior is inappropriate in that setting. Meals with staff: If frequent redirection is needed in the dining room due to behavioral concerns, inappropriate peer interactions, or specific dietary restrictions, meals may need to be consumed with staff. Early bedtime: If an individual is unable to comply with the bedtime routine, they may be given an earlier bedtime the following night. Specific Activity Restriction: If an individual is unable to demonstrate appropriate behavior during a therapeutic group or activity, they be restricted from the next such activity. A therapeutic assignment may be given to help them focus on the nature of their behavior and alternative responses. Therapeutic Assignments: Written assignments that address specific therapeutic concerns will be assigned as an individual approach or in conjunction with another restriction.

Safety Measures (cont.) Written Exercises: Written exercises are designed to assist in examining unhelpful thoughts, feelings and behaviors that an individual is experiencing or displaying. This process assists in coping with life s challenges in a more positive way. Individual Treatment Contracts: If more frequent feedback is needed due to poor impulse control or developmental concerns, an individual may be placed on an individual treatment contract/behavior plan. The contract will focus on the individual treatment issues and incorporate more frequent reinforcements. Sign-Ins: If an individual is unable to commit to a safe level of behavior on a consistent basis, or if an individual is isolating from the community, they may be placed on safety sign-ins. The frequency is established based on the nursing assessment and is gradually altered as the therapeutic issue is resolved. Loss of Telephone Privileges: If behavior in specific activities is inappropriate, points will be deducted from the individual s point sheet. A rating of Need Improvement on more than three (3) categories in one day will result in a loss of outgoing telephone privileges for the following day. An individual may also loose phone privileges if they do not follow the rules regarding phone usage or if they are aggressive or self-injurious.

SAFETY LEVELS Throughout the day, individuals will be asked to provide their safety level. A safety level is a number from 1 to 10 that is a self-assessment around how safe the individual feels at the time. Below is a guide to help individuals understand the safety level system. Honesty in reporting safety levels allow staff to better cater to individual treatment needs. 1-2 Constant suicidal/homicidal/self-harm thoughts, a plan to hurt self/others, intent to carry out the plan, not committed to safety, not agreeing to come to staff before acting on unsafe thoughts. Safety levels under 5 require individuals to complete a safety contract and may need additional staff interventions. 3-4 Constant suicidal/homicidal/self-harm thoughts, a plan to hurt self/others, no intent to carry out the plan, not committed to safety, but agreeing to come to staff before acting on unsafe thoughts. Safety levels under 5 require individuals to complete a safety contract and may need additional staff interventions. 5-6 Frequent suicidal/homicidal/self-harm thoughts, no plan to hurt self/others, committed to safety and agreeing to come to staff before acting out unsafe thoughts. 7-8 Some suicidal/homicidal/self-harm thoughts, no plan to hurt self/others, committed to safety and agreeing to come to staff before acting out unsafe thoughts. 9-10 No suicidal/homicidal/self-harm thoughts, no plan to hurt self/others, committed to safety and agreeing to come to staff before acting out unsafe thoughts. Considered completely safe.

SEARCHES Nursing staff must be certain that no individual is in possession of something that may harm either themselves or others. Safety Searches occur on admission or if a staff member suspects possession of contraband (see Contraband list). Individuals will be asked to remove their clothing in a bathroom and change into hospital gowns ( double gown search ). Individuals will then pass clothing to a staff member of the same sex who will inspect them, the clothing and the bathroom for contraband. If an individual refuses to consent to the admission safety search, individuals will not be allowed to come out of the open quiet room until they have complied. SERVICES FOR THE HEARING IMPAIRED To ensure effective communication with individuals and their companions who are deaf or hard-of-hearing, we provide appropriate auxiliary aids and services free of charge, such as: sign language and oral interpreters, video remote interpreting services, TTYs, written materials, telephone handset amplifiers, assistive listening devices and systems, telephones compatible with hearing aids, and televisions with caption capability. Please ask your nurse or other hospital staff for assistance. Should there be a concern or complaint about any services related to ensuring effective communication for individuals with special needs, please contact the Patient Advocate at 703-538-2882 during business hours or anytime to leave a message. After hours, a Nursing Supervisor is on duty to assist with concerns and issues and can be reached at 703-538-2875.

SMOKING Smoking is not permitted on the unit. Smoking materials found will be confiscated by staff and NOT returned. Bringing alcohol or illegal drugs into the program or arriving at the program intoxicated or under the influence, will result in a level of care reassessment and/or immediate discharge. TELEPHONE/TELEPHONE TIMES Cellphones are not allowed on the units at any time. Individuals will have access to the telephone at designated times. The purpose in designating specific telephone times is to reduce the number of interruptions during groups and activities. Additionally, limiting the time on the telephone allows other Individuals to make or receive calls. During telephone time, individuals will be allowed to receive 2 incoming calls that are no more than 10 minutes each and also allowed to make 1 outgoing call that is not more than 10 minutes long. To make an outside call, please dial 9 prior to the number. If you need assistance with making a call, please see a staff member. Individual phones are unable to be used for long distance calls so to make a long distance call, please discuss this with a staff member. Telephone Time is between 7:30pm-8:30pm.

TELEVISION/MOVIES/BOOKS The unit has a television in the front lounge for use. The television is to be turned off during all scheduled groups and at night. Individuals may decide which television program to watch and courtesy is expected between individuals. Staff may intervene if inappropriate shows are selected. TREATMENT TEAM During an individual s first days at Dominion Hospital, a team of professionals, including a psychiatrist, registered nurses, a licensed social worker, activity therapists, and other specialists will meet. Family members may be asked many questions at the beginning of an individual s stay to assist the team in understanding an individual s particular situation and the best way to help. The Treatment Team meets Monday through Friday. The Treatment Team is also responsible for making decisions around restrictions (Unit, Sharps, or Falls) based on an individual s behavior. Social Workers will review the treatment plan with the individual and incorporate individual preferences into the treatment plan. The members of the Treatment Team include: Psychiatrist: Directs the treatment team, provides individual therapy, prescribes medication, and develops a discharge plan. Self-Injurious Behavior Staff: Provides assessments for participation in SIB groups, conducts groups.

Treatment Team (cont.) Licensed Social Worker (Licensed Clinical Social Worker (LCSW) or Licensed Professional Counselor (LPC)): Provides individual, group and family therapy, case management and arranges for family meetings to address discharge planning goals. An individual s social worker will normally be assigned the morning after an individual s admission. If an individual is assigned at the end of the week, an individual will work with a weekend social worker. An individual s assigned social worker will contact a family at the beginning of the following week. Nursing Staff: Provides around the clock nursing care, monitors safety and behavior, coordinates treatment activities, administers medications and provides medication education, assists in the development of goals and achievement skills and individualizes the treatment plan within the guidelines established by the treatment team. Art and Activity Therapists: Provides arts and crafts, fitness, and leisure education groups and activities. Utilization Review Coordinators: Works with an individual s insurance company or managed care company to ensure that each individual receives the maximum benefits from treatment. Staff Nutritionist: Provides nutrition consults and nutrition education groups and conducts eating disorder groups. Dual Diagnosis Counselor: Provides Dual Diagnosis assessments for individuals with substance abuse issues, conducts Dual Diagnosis and recovery groups, coordinates for Alcoholics & Narcotics Anonymous sessions and assists with follow-on chemical dependency/substance abuse treatment programs.

VISITING Due to the relatively short duration of hospital stays, it is essential to focus energy on relationships with close family members. Therefore, visiting is restricted to immediate family only (parents/guardians, siblings and grandparents). Visiting outside of the scheduled times is generally not allowed. Members of the clergy may visit. Dominion Hospital asks that a call be placed first to the unit to arrange the appropriate time to visit. Outside therapists or psychiatrists may call or visit only with written consent from the parents and a written order from the attending psychiatrist. Please help us ensure unit safety and comfort by observing the procedures below: Visitors must register at the front desk in the main lobby and obtain a Visitors Pass, which they must wear during the visit. Our security staff will conduct a search of items to be taken to the Unit at this time. When arriving on the unit, visitors must sign in at the nursing station. All belongings brought onto the unit for individuals will be inspected by Unit Staff. Staff will not accept any restricted items from visitors. Due to the limited amount of space, two visitors per person will be permitted at one time (immediate family only). If more than two immediate family members come to visit, turns will need to be taken so all visitors can spend time with the patient. We ask that visitation take place in the lounge, not in the patient s room. This ensures that all our patients have a safe place to be during visiting.

Visiting (cont.) An approved adult visitor must accompany family members under the age of 18 and remain with them throughout the visit. If the individual requires intense supervision, visiting arrangements will be organized and monitored by nursing staff. Visitors and individuals must say goodbye on the unit. Individuals will not be permitted to accompany visitors to the front desk or the door. Visitors may be asked to show their badge when exiting secure areas of the hospital. Visitor Conduct Please leave valuables and electronic devices (cellphones, pagers, etc...) in your vehicle. Our Security Staff will ask you to return these items to your car before leaving the Lobby area to the Units. Do not bring bulky coats or bags on to the unit and do not leave personal belongings unattended. Visitors may not bring any food or drinks onto the unit. Health and storage concerns necessitate this restriction. Any visitor appearing to be under the influence of alcohol or drugs will not be allowed to visit and may be directed off the premises. Visiting Hours Monday-Friday 7:00pm-8:30pm Saturday, Sunday and Holidays 1:00pm-2:00pm and 7:00pm-8:00pm

Visiting on Holidays Visiting (cont.) Certain holidays are observed and will result in different visiting hours. Those holidays include: Memorial Day, Independence Day, Labor Day, Thanksgiving, Christmas Day, and New Year s Day. Please inquire with unit or PBX staff around changes in the visiting hours for these holidays. POST DISCHARGE WELLNESS CALLS To support each individual s discharge transition, Dominion Hospital offers a supportive telephone follow-up service in the days after they leave the hospital. This service is offered to each individual for their consent (via a signature) at the time of discharge. With an individual s consent, a discharge coordinator will make telephone contact with them at the number they provide within the first three days after discharge. The purpose of the calls is to ensure that each individual understands the medications they are prescribed, when and where their follow-up appointments are to occur, and generally how they are doing. Many individuals take advantage of this valuable service that is provided free of charge. To take advantage of this service, please let a nurse know at the time of discharge.

WHAT TO BRING Personal items and bags brought in upon admission and during visiting hours will be inspected by staff. Dominion Hospital discourages bringing any personal valuables to the hospital such as wallets, credit cards, money, cellphones, etc. All jewelry must be removed at admission. If these items are brought to the hospital, the items will either be sent home with a family member or friend of the individual s choosing or locked in the hospital safe. No valuables will be stored on the unit. On admission, staff will take an inventory of everything that the individual has brought with them. Individuals will be allowed to keep all unrestricted items with them and those items will become their responsibility. Individuals are encouraged to bring the following: Three to four changes of casual, comfortable clothes (storage is limited) Pajamas or nightgowns, without draw strings Shoes One pair of comfortable shoes or slippers with no laces for walking around the unit One pair of outdoor/sports shoes (laces are allowed) to be kept in a closet Jacket or sweater based on the weather